If you want an insightful take on where the medtech industry should be headed, and what is required to get it to there, listen to Eric Thépaut. The Boston Scientific Corp. senior vice-president and president of the group’s EMEA region, sat down with In Vivo minutes after stepping off the stage at the MedTech Forum 2019 (Paris). There, he delivered an upbeat take on the changing businesses environment and expectations on medtech manufacturers, as well as their changing roles in an evolving health care sector.
Transformation and talent development have become twin passions for Thépaut (pictured) in a 22-year career at Boston Scientific. He is arguably well placed to play a strong, collaborative role in taking medtech to its digitally enabled next phase. That includes identifying and championing all the new skills and approaches that will be required for the ongoing healthtech revolution to succeed. His personal business motto is “Act as one together,” a principle that lays the ground for keeping Europe attractive for innovation.
However, one thing is clear in his view: the health care agenda is still not high enough up national government priority lists. “We need health care at the top of the pile. But the world has conflicting priorities, and health care is managed by short-term issues.”
The latter point is often criticized as a persistent structural fault. There are acute challenges ahead for medtech, but also huge opportunities for the industry within health care. However, three- to five-year political tenures do not allow time to address the needs and build the infrastructures that will promote a transformed, sustainable health care future. “It needs more like a 25-30-year plan,” in Thépaut’s view. The future of health care may be arriving now, but medtech still needs a longer-term vision, in his view. For instance, investing in new therapies is usually a 10-year plan, at least.
“We still see the two contradictory mega-trends in the market: one is the aging population, creating huge demand for more and better health care; the other is low GDP growth.” In the EU and wider Europe, GDP growth is flat at present, and at best is reaching into the 1.2% to 1.8% bracket. “This very low growth makes it even more challenging to divide up the pie between all the macro- and global initiatives faced by governments."
“But where is health care’s place in this?” Europe faces the challenge of budgets under great strain, and deficits already appearing in the delivery of digitized services. Besides the consequences on medtech procurement, payers and providers of the macro-economy being under immense pressure, there is an additional, newer pressure: individuals are increasingly well-informed, keen to understand their choices and how they can be treated. They have heard the language of “outcomes, digitization, and virtual consultations,” and often make rankings and comparisons of the best institutions and GP practices. They are increasingly knowledgeable and demanding.
On the other hand, there are potential risks and complications for GPs in trying to analyze the flood of data that is emerging. So much data is being amassed. Can it all be relied upon? Might too much data be as frustrating as too little? That is a question for the medium-term.
Health care will always be unique. “We can’t commoditize it – that would not be good for the ecosystem or the patient” – Eric Thépaut
But there is no changing course now. “Digitization is going to completely transform health care. It’s happening later here [in health care] than in the consumer world, but remember, we are focusing on the patient in a highly regulated industry.” Health care will always be unique. “We can’t commoditize it – that would not be good for the ecosystem or the patient.” But it will evolve significantly.
“I believe that, within the medtech trade associations, we need to elevate our ideas and raise our voice; and we need to be bolder and take control of what’s going on ̶ not be reactive to it.” In his own role at Boston Scientific, Thépaut leads an advanced project in digital technology that is seeking to link the company more with customers.
“The patient was already at the center, but now they are going to be even more so” – Eric Thépaut.
Digitization provides the opportunity for health care professionals to be forewarned about a patient’s needs. “The patient was already at the center, but now they are going to be even more so. Information is now more fluid and quicker.” Some countries already allow for a very open dialog with patients, and that is coming to Europe soon, too, but at present, European industry is still focused on the product and what therapeutic value it can bring.
Now, it should be more about providing value for the patients. Two years ago, Boston Scientific developed a solution to problems that arise when device implant batteries expire, leading to a procedure that patients scarcely look forward to. The company’s EnduraLife Battery Technologydoubles the life of the batteries, and has been recommended by the UK’s health care watchdog NICE. In the first five years of usage, the NHS would save £5-6m ($6.25-7.5m). Per patient, it provides ecosystem savings over 15 years of $2,000 to $6,000.
Besides that, it is packaged in a device up to 11% smaller than other devices. Boston claims that it avoids patients having to return to the hospital, provides more comfort for the patient, and leads to fewer complications.
This is valued-based innovation, and it offers the perfect counter-argument to pervading claims that innovation adds to the cost of health care. Short-term costs are important to consider but it is more important to look at costs over the long-term., Thépaut noted. “Medtech has a real cost benefit, and we need to continue to focus on developing products that have positive impacts in the prevention and treatment debates.”
"Acting as one together” calls on players in the system to buy into cultural change and avoid objecting to or taking opposing views, on principle, to collective, patient-centric projects. That is whether the momentum is coming from multinationals, small and medium-size players (SMEs), industry, or regulators and authorities. “We must work together around the table, with no sacred cows.” Siloed working practices still exist, principally because legacy health care systems precisely were organized in silos. So, for example, procurement of device lines is still governed by cost per transaction. But in the public system, payments should not be transactional episodes, based on each use of a product. Here, reward systems must be set at earlier stages, when health care policies are being defined.
In the private sector, manufacturers can have interactions with decision-makers and build different payment models. These must be payments that focus less on product volume, but more on value – for example, risk-sharing models. But in general, changing payment structures takes time, which is why it is wise for manufacturers to start small.
But more data are becoming available to show that patients using certain types of device are, say, suddenly no longer making regular visits to A&E. This is the kind of story that hits home, eventually. “We need to show more of these.”
Similarly, in the changing world of health care, the value-based approach is making professionals more interested in knowing what patients think. Surveys of patients are thus a more regular event, asking questions such as
Such interaction is designed to identify those approaches that have positive effects in the patient community. The information can then be conveyed to payers.
This is admittedly a major leap compared with the practices of the past, but for Thépaut, it is where medtech is headed. “Be optimistic, talk with early adopters and leaders, and try to build the future,” he advised fellow industry players.
Reformers tend to get a lot of pushback on their ideas, at least in the early stages, and problems can beset those who aim too high or try to “fix the world.” Thépaut’s response: keep it simple and slice it up. “Identify where change can happen easily and find the believers – and those who want to be different,” he recommended. This means taking a regional system approach – like, for instance, the Catalonia model [whose Catalan value-based health care ideals were profiled at MTF 2019]. Generally, “find the people who can push the right buttons.”
“As a leader, you’re not always the best informed,” Thépaut admitted, “but you still have to get the right information.” And more advice: “Don’t panic about the changes, but work on the insights, listen to the medical community and the health care authorities, and try to investigate what the challenges really are.” Also: “Go deep and be diverse, including in the way you sample opinions.”
These are first steps that are developed by a core team, and they should be followed by a vision of what “good” can look like in a health care system.
One major leadership challenge in such a transition is the need for a guiding coalition to identify quick-win milestones. “People won’t follow you if they don’t see short-term change.” These don’t need to be huge challenges, but rather should at least provide the early successes that can be built upon.
Thépaut further advised that manufacturers should to talk to selected institutions, regulatory bodies, industry members and patient associations. “Find early adopters who can think about building the health care system differently. Some are more forward-thinking than others,” he said. It is also better to target regions, not whole countries. The aim is to build a business case that can be published in medical journals, which thereby starts a debate. “This is how to secure change: simplify, be factual, go regional, get people around the table, win trust, and advance.”
The talk around innovation very easily leads to buzzwords, which can over-inflate realities at the beginning (when there is “nothing” to hold on to), but later, understate what continues to be achieved, he observed. In the value-based arena, for instance, a lot is happening, even if progress is not as fast or and major as expected. “It’s a long-term initiative, and a step-by-step approach is needed.”
Another example is the EU Medical Device Regulation (MDR). “It’s not new, and we [Boston] have been preparing for it for more than three years.” The transition is painful, however, and some executives in the industry are openly saying that the MDR is not good. Thépaut is more optimistic, and does not go along with that view. However, he was adamant about one thing: the MDR must not slow down access to innovation for patients.
Boston Scientific’s view of the future also includes a large element of partnerships. It spends 10% on R&D – the level of a high-tech company – and complements this with M&A; last year seven acquisitions were made, on top of which VC investments were made in another 30-40 companies, with an option to buy. “We do this a lot; we are not going to reinvent the wheel, which is an approach our CEO [Mike Mahoney] brought in a few years ago.” This is one of the secrets of the company’s success, said Thépaut. Others are “not only listening, but also giving insight, collaborating and acting as one together.”
The MedTech Forum & The Global MedTech Compliance Conference 2020 will be held in Berlin, Germany, on 25-27 May 2020.